LAND USE RR SCANNED to- 21_I'J ' \ 5-1 0 cripitnUCOC
Ini Application Date: T` -' , 10_11-10 V V Application # / U# . J (/ Go 2. 5 '7 1 I Pig
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COUNTY OF HARNETT RESIDENTIAL LAND USE APPLICATION
Central Permitting 108 E. Front Street, Lillington, NC 27546 Phone: (910) 893 -7525 Fax: �(910) 893-2793 www.harnett.org /permits
LANDOWNER: /- zeJAL / ( A rat t-I .. 1-11 j Mailing Address:
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City: IV (Ji I4G State: -/ ip: - t f ? 7.:ontactft 1 <% tI J I f Email: d at a , tact/ 33 OC,
APPLICANT': Mailing Address:
City: State: Zip: Contact# Email:
*Pleaseflll out applicant information n different than landowner 717Z?
CONTACT NAME APPLYING IN OFFICE: COP? /1.2- 4 PhonA # / C) �y •
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PROPERTY LOCATIONS /i bdivision: l I.Co CI ^ - ) 9 - / LaK �' • `*zS )• I ^Lot #: / 0 Lot Size: 7q�CSF
State Road # t (, , / 7 State Road Name: t,, .... � it �
_ L / / 4 , l I Map Book&Page: Cil i9 50
Parcel: y°?' is;.. i' • / C .' ..' L . li r) PIN: C lip' loT' .J822
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Zoning: jF /� oeZOne: X Watershed: �' , N f Deed Book &Page: ,`h: E2c):ROWer'Cdinpany*: / ra--l'
New structures with Progress Energy as service provider need to supply premise number -. . - from Progress Energy.
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SPECIFIC DIRECTIONS TO THE PROPERTY FROM LILLINGTON: 4 cec.L.t S1Dd
5 e , f-c cc 4 G-.a Izts fit (� m, Ca / - .11ow -/a
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51.8 Ga`' S
PROPOSED USES x S r
/ ., �' Monolithic
8" SF D: (Size;' x `i) # Bedrooms: # Baths:8asement(w /wo bath): Garage: ✓ Deck: Crawl Space: Slab. Slab:
(Is the bonus room finished? (_) yes (_)no w/ a closet? ( ) yes Lino (if yes add in with # bedrooms)
❑ Mod: (Size x ) # Bedrooms *Baths Basement (w/wo bath)_ Garage:_ Site Built Deck:_ On Frame Off Frame_
(Is the second floor finished? (_) yes ( )no Any other site built additions? L.J yes (_)no
❑ Manufactured Home: _SW _DW _TW (Size x ) # Bedrooms: _ Garage: (site built? ) Deck: (site built? )
❑ Duplex: (Size x ) No. Buildings: No. Bedrooms Per Unit:
❑ Horne Occupation: # Rooms: Use: Hours of Operation: #Employees:
❑ Addition /Accessory/Other: (Size _ x ) Use: Closets in addition? (_) yes Lino
Water Supply: /County Existing Well New Well (4 of dwellings using well )*MUST have operable water before final
Sewage Supply: _ New Septic Tank (Complete Checklist) Existing Septic Tank (Complete Checklist) t'ounty Sewer
Does owner of this tract of land, own and that contains a maanu fact within five hundred feet (500') of tract listed above? ( ) yes (�+" no
Structures (existing or proposed): Single family dwellings: Manufactured Homes: Other (specify): '—"
Required Residential Property Line Setbacks: Co ments: Io - 1-1 - 10 Coror- C.cNM44E0 1 G5 - O, / Gizmo rlsL
Front Minimum 3C Actual /3� i SIT( PI 4-I-I i3'4 0 al scow TO TEES Cite))
Rear (O( 1h -24 -0 O, r0r Cs'eko PLAN s r44n(a • 1/4501, OE
Closest Side a a ` ) 3 S C&I, T' 2it^ ' s I ^f )444,,," c.
SidestreeVcomer lot .'"3 l 7 C
Nearest Building
on same lot
If permits are granted I agree to conform to ordinan and laws f the State of North Carolina regulating such work and the spedfications of plans submitted.
I hereby state that foregoing statements ar accurate an correct the best of my knowledge. Permit subject to revocation if false information is provided.
Signature of Own r Owner's Agent Date
"This application expires 6 months from the initial date If permits have not been issued"
A RECORDED SURVEY MAP, RECORDED DEED (OR OFFER TO PURCHASE) AND PLAT ARE REQUIRED WHEN APPLYING FOR LAND USE APPLICATION
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